Provider First Line Business Practice Location Address:
PRIME HEALTH MD
Provider Second Line Business Practice Location Address:
1801 PEACHTREE ST NE SUITE 145
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-778-7645
Provider Business Practice Location Address Fax Number:
770-664-8298
Provider Enumeration Date:
11/08/2006